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Insurers Prepare to Fight RADV Rule

The Risk Adjustment Data Validation (RADV) rule was finalized today. The new rule for governing how CMS audits Medicare Advantage plans for overpayment due to inflated risk adjustment could cost insurers billions of dollars.

Virtual Care is Evolving into 2023

Virtual care has been a favored service among many healthcare consumers as its users have shared they want more out of it, according to a 2022 Virtual Care Survey Report by Summus.

Building Relationships to Improve Access to Healthcare, Improve Health Equity

Connecting the healthcare system and patients in a positive, empathetic, respectful way may help lessen the fatigue many groups have with the healthcare system at-large and individual healthcare providers, while improving health equity.

The Future of Savings in Humira Biosimilars Drug Costs Are Low

As a dozen Humira Biosimilars are set to enter the market this year, it seems to be unlikely that they will drive down drug costs in the future.

FDA Updates for the Week of Jan. 23, 2023

The FDA approved a new drug for type 2 diabetes and a new BTK inhibitor for rare blood cancer while Keytruda got another indication in lung cancer. But Evusheld lost its EUA for COVID-19. The agency accepted an sNDA for Jardiance for CKD and officials said they plan to hold advisory committee meeting for Biogen’s ALS drug.

Cost Savings for Insulin Are in Order for Medicare Part B, D Enrollees

Results from a recent U.S. Department of Health and Human Services (HHS) analysis shared that Medicare beneficiaries who use insulin would have saved $734 million in Part D and $27 million in Part B if these caps had been in effect in 2020

Going on Offense Against Fraud, Waste and Abuse in Behavioral Telehealth: 3 Key Actions

Telehealth, especially for behavioral health, has created new opportunities for dishonest individuals to file fraudulent claims. Health plans can take steps to stop the fraud before it happens.

Interoperability Is Happening — Why Natural Language Processing Is Such an Essential Part of It

Some 80% of the clinical data is in an unstructured or semi-structured form within the notes sections of electronic health records. Natural language processing can "read” those notes and extract information without fatigue.

Medicaid Enrollees Appear To Be Missing Out on Targeted Treatment for NSCLC, Harvard Researchers Find

1 out 3 Medicaid patients who might have benefited from targeted therapy —mainly Tagrisso and Alecensa — for metastatic lung cancer did not receive it, according to estimates by a trio Harvard-affiliated researchers.

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